The association of self-injurious behaviour and suicide attempts with recurrent idiopathic pain in adolescents: evidence from a population-based study

Spatial, geographic, and demographic factors associated with adolescent and youth suicide: a systematic review study

Background

Suicide is a public health issue and a main cause of mortality among adolescents and the youth worldwide, particularly in developing countries.

Objectives

The present research is a systematic review aiming to investigate the spatial, geographical, and demographic factors related to suicide among adolescents and the youth.

Methods

In this systematic review, two researchers examined PsycINFO, Web of Science, Scopus, and PubMed databases on December 7th, 2022 with no time limits from the beginning of publication until 2022 to identify the primary studies on spatial and geographic analysis on adolescent and youth suicides. Once duplicate studies were identified and removed, the titles and abstracts of studies were examined and irrelevant studies were also removed. Finally, 22 studies were reviewed based on the inclusion criteria.

Results

Our findings show that suicide rates are generally higher among men, residents of rural and less densely populated regions, coastal and mountainous regions, natives, 15-29 age group, less privileged populations with social fragmentation, unemployed, divorced or lonely people, those who live in single parent families, people with mental health issues, and those with low levels of education.

Conclusions

Stronger evidence supports the effects of geographic and demographic variables on youth and adolescent suicide rates as compared with spatial variables. These findings suggest that policy makers take spatial and demographic factors into consideration when health systems allocate resources for suicide prevention, and that national policymakers integrate demographic and geographic variables into health service programs.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42023430994.

Identifying and Managing Suicidality in Children and Adolescents with Chronic Pain: Evidence-Based Treatment Strategies

Children and adolescents with chronic pain are at an increased risk of suicidality. This narrative review article aims to inform clinical practice in the assessment and management of suicidality in youth with chronic pain. The article begins with a survey of the background and prevalence of youth with chronic pain. A review of the current evidence behind the increased risk of suicidality in youth with chronic pain follows. Contextualization of this data with general tenets of child and adolescent suicide risk and risk assessment is provided. Suicidology theory including the interpersonal theory of suicide is overviewed to help clinicians to conceptualize the reviewed data. Guiding parameters for the suicide risk assessment and management planning is presented. Concluding recommendations are made to guide clinical practice in the assessment and management of suicidality in youth with chronic pain.

Child and adolescent psychiatry staff's knowledge on pain management

OBJECTIVE

To assess the level of child and adolescent psychiatric staff's knowledge regarding pain management, to determine group differences between the medically more educated (physicians, nurses) and the less educated (psychologists, educators, special therapists) and to investigate the influence of gender, age, or professional experience as well as staff's own pain experiences.

METHODS

A total of 193 staff members from different professional backgrounds from three independent child and adolescent psychiatry clinics in Northern Germany were tested using the German version of the Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain Shriner's revision (PNKAS-Sr).

RESULTS

In total, the staff scored correctly 66% of the inventory questions. There was no difference between medically more educated and less educated staff members regarding the knowledge of pain management. The main factors influencing PNKAS score were age, profession, and pain education training.

CONCLUSIONS

Although chronic pain is not one of the main aspects of continuing education in child and adolescent psychiatry, the resulting level of knowledge was comparable to results of similar surveys with paediatric staffs. Nevertheless, further education is needed to enhance knowledge and understanding of children's pain in child psychiatry staff in order to professionally treat patients with chronic somatic and mental illnesses.

A longitudinal study of bidirectional associations between frequent pain and insomnia symptoms in adolescents

BACKGROUND

Chronic pain and insomnia symptoms are prevalent in adolescents. This study examined the prospective associations between pain and insomnia symptoms in a large sample of adolescents.

METHODS

A total of 7072 adolescents (mean age = 14.6 years) participated in a longitudinal study of behavior and health in Shandong, China. A baseline survey was conducted in November-December of 2015, and a follow-up survey was conducted one year later. A self-administered questionnaire was used to assess headache, stomachache, other nonspecific pain, depression, substance use, and family environment. The Youth Self-Rating Insomnia Scale was used to measure insomnia symptoms.

RESULTS

At baseline and 1-year follow-up, frequent pain was reported by 8.4% and 7.8% of the sample, respectively; moderate to severe insomnia symptoms were reported by 15.2% and 14.8%, respectively. Logistic regression analyses showed that frequent pain at baseline was significantly associated with increased odds of incident insomnia symptoms at 1-year follow-up (odds ratio [OR] = 1.70, 95% confidence interval [CI] = 1.23-2.34) while adjusting for adolescent and family covariates. On the other hand, insomnia symptoms at baseline were significantly associated with increased odds of incident frequent pain at 1-year follow-up (OR = 2.00, 95% CI = 1.50-2.68). The 3 types of pain (ie, headache, stomachache, and other nonspecific pain) had similar associations with insomnia symptoms.

CONCLUSIONS

The findings suggest that the associations between frequent pain and insomnia are bidirectional, independent of multiple adolescent and family covariates. These findings stress the importance of assessment and management of both pain and insomnia symptoms in adolescents in routine clinical practice and school-based intervention programs.

A Theoretical Endogenous Opioid Neurobiological Framework for Co-occurring Pain, Trauma, and Non-suicidal Self-injury

PURPOSE OF REVIEW

Individuals with chronic pain are significantly more likely to have experienced overwhelming trauma early and often in key developmental years. There is increasing acknowledgment that childhood trauma disrupts how individuals process and cope with both physical and emotional pain. Emerging studies acknowledge elevated rates of non-suicidal self-injury (NSSI) in chronic pain populations. This review provides a theoretical framework to understand the relationship between NSSI behavior and pain experience in persons with chronic pain and childhood trauma histories. We discuss how NSSI may act to regulate neurobiological (e.g., endogenous opioid systems) and psychological (e.g., heightened negative affect and emotion dysregulation) systems affected by childhood trauma, leading to temporary pain relief and a cycle of negative reinforcement perpetuating NSSI. As these concepts are greatly understudied in pain populations, this review focuses on key areas relevant to chronic pain that may provide a testable, conceptual framework to support hypothesis generation, future empirical investigation, and intervention efforts.

RECENT FINDINGS

See Fig. 1. See Fig. 1.

Associations between pain and depressive symptoms: A longitudinal study of Chinese adolescents

AIMS

Pain and depressive symptoms are prevalent in adolescents. Data on the association between pain and depressive symptoms in the general adolescent population are limited. The purpose of this study was to investigate the prospective associations of headache, stomachache, and other nonspecific pain with depressive symptoms in a large sample of Chinese adolescents.

METHODS

A total of 7072 adolescents who participated in the baseline survey and were followed up 1 year later were included in the prospective analysis. Participants completed a self-administered questionnaire to assess three types of pain (headache, stomachache, and other nonspecific pain) and demographics. Depressive symptoms were assessed by the Center for Epidemiology Studies Depression Scale. Logistic regression models were conducted to evaluate the associations between pain and depressive symptoms.

RESULTS

The prevalence and incidence rates of depressive symptoms significantly increased with elevated pain frequencies. After adjusting for insomnia symptoms and other adolescent and family covariates, frequent headache (OR=2.39, 95% CI =1.37-4.16) and other nonspecific pain (sometimes pain: OR=1.57, 95% CI =1.14-2.15; frequent pain: OR=2.78, 95% CI =1.33-5.82) were significantly associated with increased risk of depressive symptoms 1 year later. Study limitation: Pain and depressive symptoms were self-reports.

CONCLUSIONS

The findings suggest that frequent pain is associated with subsequent depressive symptoms. Further research is needed to determine the causal relationship between pain and depressive symptoms in adolescents.

Co-Occurring Trauma and Non-Suicidal Self-Injury Among People With Chronic Pain: A Systematic Review

PURPOSE OF REVIEW

Trauma and posttraumatic stress are common among individuals with chronic pain and contribute to increased morbidity and impairment. Individuals with trauma and chronic pain may be prone to non-suicidal self-injury, a relatively common yet risky self-regulatory behavior. There is a dearth of research on the intersection of trauma, chronic pain, and non-suicidal self-injury (NSSI). We conducted a systematic review of the extant literature.

RECENT FINDINGS

Five quantitative and eight case reports were identified. Only one quantitative study reported specifically on NSSI. Self-harm rates varied across studies, though appeared elevated among patients with chronic pain. Childhood trauma was linked to this co-occurrence. Causal links between trauma, NSSI, and pain are proposed, highlighting the need for a comprehensive theoretical model. We recommend assessing for childhood trauma when treating patients with chronic pain and querying regarding NSSI when patients present with indicators of NSSI risk and to treat or refer such patients to specialized treatment.

Rapid Evidence and Gap Map of virtual care solutions across a stepped care continuum for youth with chronic pain and their families in response to the COVID-19 pandemic

ABSTRACT

Poor access to pediatric chronic pain care is a longstanding concern. The COVID-19 pandemic has necessitated virtual care delivery at an unprecedented pace and scale. We conducted a scoping review to create an interactive Evidence and Gap Map of virtual care solutions across a stepped care continuum (ie, from self-directed to specialist care) for youth with chronic pain and their families. Review methodology was codesigned with 8 youth with chronic pain and 7 parents/caregivers. Data sources included peer-reviewed scientific literature, gray literature (app stores and web sites), and a call for innovations. Records were independently coded and assessed for quality. Overall, 185 records were included (105 scientific records, 56 apps, 16 web sites, and 8 innovations). Most virtual care solutions were applicable across pediatric chronic pain diagnoses, with the greatest proportion at lower levels of stepped care (ie, >100 self-guided apps and web sites). Virtual delivery of psychological strategies was common. Evidence gaps were noted at higher levels of stepped care (ie, requiring more resource and health professional involvement), integration with health records, communication with health professionals, web accessibility, and content addressing social/family support, medications, school, substance use, sleep, diet, and acute pain flares or crises. Evidence and Gap Maps are a novel visual knowledge synthesis tool, which enable rapid evidence-informed decision-making by patients and families, health professionals, and policymakers. This evidence and gap map identified high-quality virtual care solutions for immediate scale and spread and areas with no evidence in need of prioritization. Virtual care should address priorities identified by youth with chronic pain and their families.

A cross sectional study of non-medical use of prescription opioids and suicidal behaviors among adolescents

Background

Non-medical use of prescription opioids (NMUPO), defined as taking an opioid in a manner or dose other than prescribed, taking someone else’s, or for the feelings that it produces, has been reported by 5 to 20% of adolescents, and is associated with a two fold increase in suicidal behaviors among adolescents. Adolescents with long-term health problems (LTHP) have poorer mental health and may seek NMUPO for pain relief that is not obtained through standard care. For this study, we measured the association between NMUPO and suicidal behaviors, and further assessed effect modification by LTHP hypothesizing the association between NMUPO and suicidal behaviors was stronger for adolescents with LTHP.

Findings

For students with LTHP, 13.5% reported suicide ideation, while 8.0% of students without LTHP reported suicide ideation. For suicide attempt, 4.4% of students with LTHP reported a suicide attempt, while 2.1% of students without LTHP reported a suicide attempt. The proportion of students who reported suicide ideation and attempts increased with higher occasions of NMUPO. Adjusted logistic regression models found increased odds of suicide ideation (OR (95% CI): 1–5 occasions: 2.3 (2.0–2.6); > 6 occasions: 2.7 (2.2–3.8)) and suicide attempts (OR (95% CI): 1–5 occasions: 3.2 (2.7–3.7); > 6 occasions: 4.1 (3.1–5.3)) for students who reported NMUPO. An interaction term for NMUPO and LTHP was then added to the models. Effect modification was not present on the multiplicative scale. On the additive scale, evidence of effect modification was observed: higher risk was indicated for students with LTHP versus no LTHP for both suicide ideation (Predicted risk (95%CI): > 6 occasions NMUPO, LTHP: 0.24 (0.18–0.29); No LTHP: 0.16 (0.13–0.18)) and attempt (Predicted risk (95%CI): 1–5 occasions NMUPO, LTHP: 0.08 (0.07–0.10); No LTHP: 0.05 (0.05–0.06); > 6 occasions NMUPO, LTHP: 0.11 (0.07–0.15); No LTHP: 0.06 (0.05–0.08)).

Conclusions

The results affirmed that NMUPO is associated with suicidal behaviors among adolescents. A pattern also emerged of higher risk of suicidal behaviors for those with LTHP who reported NMUPO. Areas of further inquiry should explore chronic medical or pain conditions as possible modifying pathways that could exacerbate the effects of NMUPO on suicidal behaviors specific to an adolescent population.

Prospective Associations of Frequent Pain Symptoms With Suicidal Behavior in Adolescents

Chronic pain and suicidal behavior are prevalent in adolescents. This longitudinal study examined the associations between pain symptoms and suicidal behavior in adolescents. A total of 7,072 adolescents participated in a follow-up study of behavior and health in Shandong, China. A self-administered structured questionnaire was used to assess pain symptoms (headache, stomachache, and other nonspecific pain), insomnia, anxiety/depression, substance use, stressful life events, prior suicidal behavior, and family environment in November-December in 2015. One year later, a follow-up survey was conducted. Mean age of the sample was 14.6 years, and half were female. Of the sample, 44.8% and 8.4% reported having one or more pain symptoms "sometimes" and "often", respectively. A total of 22.4% and 10.6% reported having lifetime suicidal behavior at baseline and subsequent suicidal behavior over the 1-year follow-up, respectively. Frequent pain was significantly associated with increased risk of suicidal behavior at baseline (OR=1.64, 95%CI=1.32-2.03) and during the subsequent year (OR=1.50, 95%CI=1.17-1.93) while adjusting for adolescent individual and family covariates. Among adolescents without a history of prior suicidal behavior, frequent pain was significantly associated with an approximately 70% increased risk of incident suicidal behavior (OR= 1.69, 95%CI=1.14-2.51). In conclusion, frequent pain appears to be predictive of adolescent suicidal behavior one year later. PERSPECTIVE: This article presents the prospective associations of frequent pain symptoms with suicidal behavior in adolescents. Frequent pain was associated with a 50-70% increased risk of suicidal behavior 1 year later. The finding underscores the importance of pain assessment and treatment in comprehensive suicide prevention efforts in adolescents.

Associations of frequent pain symptoms with excessive daytime sleepiness in adolescents: a longitudinal study

STUDY OBJECTIVES

Pain symptoms, sleep disturbance, and daytime sleepiness are common in adolescents. This study examined the cross-sectional and prospective associations between pain symptoms and excessive daytime sleepiness (EDS) in a large sample of adolescents.

METHODS

Participants were 7,072 adolescents (mean age = 14.6 years) in a follow-up study of behavior and health in Shandong, China. A self-administered structured questionnaire was used to assess pain symptoms (headache, stomachache, and other general pain), body weight and height, sleep, anxiety/depression, substance use, and family environment in November-December in 2015 and one year later. The Chinese adolescent daytime sleepiness scale (CADSS) was used to measure daytime sleepiness.

RESULTS

Of the sample, 19.8% and 23.2% had moderate or severe EDS at baseline and at 1-year follow-up, respectively. The prevalence and 1-year incidence rates of EDS significantly increased with the frequencies of pain symptoms. Frequent pain was significantly associated with increased risk of EDS at baseline (OR=2.01, 95% CI=1.56-2.59), incident EDS (OR=1.41, 95% CI=1.03-1.93), and persistent EDS (OR=2.17, 95% CI=1.52-3.09) while adjusting for adolescent and family covariates, including anxiety/depression, nocturnal sleep duration, insomnia symptoms, frequent snoring, body mass index, and hypnotic use. Similar associations were observed across headache, stomachache, and other pain.

CONCLUSIONS

Frequent pain is significantly and independently associated with increased risk of EDS. Our findings suggest that assessing and treating pain symptoms is important to improve healthy sleep and reduce risk of EDS in adolescents. Further research is needed to understand the underlying psychological and neurobiological mechanisms between pain and daytime sleepiness in adolescents.

The Co-occurrence of Pediatric Chronic Pain and Depression: A Narrative Review and Conceptualization of Mutual Maintenance

OBJECTIVES

Internalizing mental health issues co-occur with pediatric chronic pain at high rates and are linked to worse pain and functioning. Although the field has prioritized anxiety and posttraumatic stress disorder, little is known about co-occurring depression and chronic pain in youth, despite its high prevalence. The purpose of this narrative review was to examine the existing literature on the co-occurrence of pediatric chronic pain and depressive disorders and symptoms and propose a conceptual model of mutual maintenance to guide future research.

METHODS

The literature from both fields of pediatric pain and developmental psychology were searched to review the evidence for the co-occurrence of pediatric chronic pain and depression. Conceptual models of co-occurring mental health issues and chronic pain, as well as child depression, were reviewed. From both literatures, we provide evidence for a number of proposed child, parent, and neurobiological factors that may serve to mutually maintain both conditions over time. On the basis of this evidence, we propose a conceptual model of mutual maintenance and highlight several areas for future research in this area.

RESULTS

Evidence was found for the prevalence of depression in pediatric chronic pain as well as the co-occurrence of both conditions. The key mutually maintaining factors identified and proposed included neurobiological, intrapersonal (eg, cognitive biases, sleep disturbances, emotion regulation, and behavioral inactivation), and interpersonal (eg, parent mental health and pain, genes, and parenting) factors.

DISCUSSION

Given the dearth of research on mutual maintenance in this area, this review and conceptual model could drive future research in this area. We argue for the development of tailored treatments for this unique population of youth to improve outcomes.

The relationship between pain and suicidal vulnerability in adolescence: a systematic review

Leading suicide theories and research in adults suggest that pain can exacerbate the suicidal risk of an individual. Although pain and suicidality (including suicidal ideation, behaviour, and death by suicide) both increase in prevalence during adolescence, the relationship between these factors remains unclear. We aimed to systematically review the empirical evidence for such an association in adolescence. We included 25 observational studies published between January 1961 and December 2018, exploring the potential association between pain and suicidality in adolescents aged 10-19 years. Across various samples and manifestations of pain and suicidality, we found that pain approximately doubles the suicidal risk in adolescents, with a few studies suggesting that pain can predict suicidality longitudinally. Although depression was an important factor, it did not fully explain the association between pain and suicidality. Evidence for associations between pain characteristics and suicidality is sparse and inconclusive, and potentially hides developmental differences between adolescents and adults. Identification of psychological mediators and moderators is required to develop interventions tailored to the needs of adolescents experiencing pain. This study is registered with the PROSPERO database, number CRD42018097226.

Neurocognitive and psychological effects of persistent pain in pediatric sickle cell disease

BACKGROUND

Pain is a major complication of sickle cell disease (SCD), spanning vaso-occlusive crises and persistent pain. Although it is known that persistent pain is associated with considerable impairment in youth without SCD, little is known about the functional effects of persistent pain in SCD. The current study aimed to (a) characterize persistent pain in youth with SCD and (b) determine the extent to which youth with SCD and persistent pain differ in disease morbidity, functional impairment, and neurocognitive and psychological functioning.

PROCEDURE

Eighty-nine participants (ages 7-16) and caregivers completed questionnaires (BRIEF [Behavior Rating Inventory of Executive Function], Conners-3 [Conners-third edition], and PedsQL™-SCD Module, where PedsQL is Pediatric Quality of Life Inventory). Participants completed neurocognitive tests WISC-V [Wechsler Intelligence Scale for Children-fifth edition], WJ-III [Woodcock Johnson Tests of Achievement-third edition], and WIAT-III [Wechsler Individual Achievement Test-third edition]). Youth were classified as having persistent pain if they reported daily pain for 7 days. Chi-square and independent sample t-test analyses were used to assess group differences (those with vs without persistent pain).

RESULTS

Patients with persistent pain (n = 18) reported lower health-related quality of life (P = .000). Caregivers were more likely to rate youth with persistent pain as having lower planning/organization abilities (P = .011) and clinically elevated symptoms of defiance/aggression and oppositional defiance (Ps = .00; .01). Patients with persistent pain demonstrated poorer working memory (P = .023) and processing speed (P = .027), and fewer demonstrating reading fluency abilities in the average or above range (P = .026).

CONCLUSIONS

Youth with SCD and persistent pain are at risk for psychosocial and neurocognitive impairments, suggesting that persistent pain may be an important indicator of disease burden. Furthermore, disease management may be enhanced by assessing cognitive and psychosocial functioning and incorporating interdisciplinary treatments addressing impairment associated with persistent pain.

Examining the Association between Weapon Carrying on School Property and Suicide Attempt among Adolescents in the United States

Suicidal behaviors among adolescents in the United States are the second leading cause of death and has been steadily increasing over the years. Although access to and possession of a weapon may facilitate the transition from suicidal ideation to a suicide attempt, few studies have examined the association between weapon carrying and suicide attempts among adolescents. The objective of this study was to examine the association between weapon carrying on school property and suicide attempt among adolescents. Data for this study came from the 2017 Youth Risk Behavior Surveillance System. A sample of 14,547 adolescents aged 14-18 years old (50.5% female) was analyzed using logistic regression. Of the 14,547 adolescents, 4% carried a weapon on school property, and 7.7% attempted suicide during the past 12 months. In the multivariate logistic regression, adolescents who reported carrying a weapon on school property had more than double the odds of attempting suicide when compared to their counterparts who did not carry a weapon on school property. Other significant predictors of suicide attempt include sexual minority, history of forced sexual intercourse, school bullying and cyberbullying victimization, feeling sad or hopeless, and substance use. Examining the association between weapon carrying and suicide attempt among adolescents would contribute to early identification of adolescents who are likely to engage in suicidal behaviors.

Self-Directed Violence After Medical Emergency Department Visits Among Youth

INTRODUCTION

Identifying medical encounters that precede self-directed violence may allow for important prevention opportunities. This study examined the risk of self-directed violence after visiting the emergency department for a range of physical health conditions among youth.

METHODS

This retrospective cohort study used 2012-2013 statewide emergency department data from six states. Among patients aged 15-29 years, the exposure group included 2,192,322 emergency department visits for 16 selected conditions, coded by whether visits for those conditions were the first, second, or third or later visit for that condition. Emergency department visits for a minor infection served as the reference group (n=149,163). A Cox proportional hazard model was used to assess the risk of a self-directed violence event within 6 months for each condition. Analyses were conducted in 2017.

RESULTS

Overall, 8,489 (0.4%) of all patients visited the emergency department for self-directed violence over a 6-month period. Initial visits for epilepsy or seizures conveyed a markedly elevated hazard ratio for subsequent self-directed violence at 6.0 and 5.7, respectively (p<0.001). Initial visits for other conditions showed moderately elevated risk with hazard ratios primarily <2. Second visits for various pain symptoms, syncope, vomiting, or non-self-directed violence injury also had a 3- to 5-fold increase in hazard ratios for subsequent self-directed violence. Hazard ratios for third or later visit increased to 8.8 for back pain, 6.9 for headache, about 5 for abdominal pain, dental complaints, and non-self-directed violence injury (p<0.001).

CONCLUSIONS

Young people presenting to the emergency department for certain medical conditions are at an increased risk of subsequent self-directed violence. An awareness of these patterns may help guide screening efforts for suicide prevention in clinical settings.

Chronic pain and suicide risk: A comprehensive review

Death by suicide is one of the leading causes of mortality worldwide. Because individuals with chronic pain are at least twice as likely to report suicidal behaviors or to complete suicide, it is of utmost importance to target which risk factors contribute the most to increasing suicidality. This comprehensive review aims to provide an update on research advancements relating to the identification of potential risk factors for suicidality in individuals with chronic pain. Supporting the results of prior reviews, we found robust evidence that chronic pain itself, regardless of type, was an important independent risk factor for suicidality. The only sociodemographic factor found to be associated with suicidality in individuals with chronic pain was being unemployed/disabled. Depressive symptoms, anger problems, harmful habits (e.g. smoking, alcohol misuse, illicit drugs), childhood or adulthood adversities, and family history of depression/suicide were all also identified as general risk factors. Regarding pain-related factors, sleep problems, poorer perceived mental health, concurrent chronic pain conditions, and more frequent episodes of intermittent pain, were all found to be predictors of suicidality. Unexpectedly, pain characteristics (e.g. type, duration, and intensity/severity) and physical status (e.g. pain interference or disability) were not related to suicide risk. We also identified promising new psychosocial factors (e.g. mental defeat, pain catastrophizing, hopelessness, perceived burdensomeness and thwarted belongingness) associated with suicidality outcomes. A large number of these factors are amenable to change through targeted intervention, highlighting the importance of comprehensively assessing chronic pain patients at risk for suicide, while also incorporating a suicide prevention component into chronic pain management programs.

Suicidal Ideation and Suicide Attempts in Middle-Aged Women Attending a Primary Care Center: A Cross-Sectional Study in Mexico

BACKGROUND

Very little is known about suicide attempts in middle-aged women in Mexico. The aims of this study were to determine: 1) the prevalence of suicidal ideation and suicide attempts in middle-aged women in Durango City, Mexico; and 2) the suicide attempt prevalence association with the sociodemographic, clinical, and behavioral characteristics of the women studied.

METHODS

Through a cross-sectional study, 395 middle-aged women were surveyed. Suicidal ideation, suicide attempt data, and the characteristics of the women were obtained with the aid of a questionnaire. Bivariate and multivariate analyses were used to determine the association between suicide attempts and the characteristics of women.

RESULTS

Of the 395 women (mean age: 46.97 ± 5.34 years) studied, 50 (12.7%) had suicide ideation, and 20 (5.1%) had suicide attempts. The number of suicide attempts among these 20 women varied from 1 to 10 times. The most frequent method used for suicide attempt was intake of medicaments (in 11 women). None of the sociodemographic characteristics was associated with suicide attempts. Women with suicide ideation, abdominal pain frequently, and reflexes impairment had a significantly higher frequency of suicide attempts than those without these characteristics. Logistic regression of behavioral variables showed that only the variable alcohol consumption was independently associated with suicide attempts (odds ratio = 2.82; 95% confidence interval: 1.01 - 7.84; P = 0.04).

CONCLUSIONS

Results suggest that suicidal ideation and suicide attempts are prevalent among women of middle-age attending a public primary care center in Durango City. This is the first report of an association between suicide attempts and reflexes impairment. Factors associated with suicide attempts found in this study may help in the design of preventive measures against suicide.

Depression and catastrophizing predict suicidal ideation in tertiary care patients with interstitial cystitis/bladder pain syndrome

INTRODUCTION

We sought to evaluate psychosocial factors as predictors of suicidal ideation (SI) in a tertiary care outpatient sample of women suffering from interstitial cystitis/bladder pain syndrome (IC/BPS).

METHODS

The patients are women managed at tertiary care centres (n=190). Controls were recruited from the community (n=117). Both groups completed questionnaires on demographics, pain (McGill Pain Questionnaire), IC/BPS symptoms, and psychological variables. Univariate and multivariate hierarchical regression modelling was conducted to examine the strength of associations and unique effects of psychosocial variables on patient SI.

RESULTS

Compared to 6% in healthy controls, 23% of patients endorsed SI in the past two weeks. Correlations between SI, depression, and catastrophizing across controls and cases show that for controls, SI is associated with greater pain (0.31; p<0.01) and depression only (0.59; p<0.01). For tertiary care centre cases, SI is associated with pain (0.24; p<0.01), depression (0.64; p<0.01), and catastrophizing (0.35; p<0.01). Regression analyses indicated that psychosocial variables accounted for a significant amount of variance over and above IC/BPS symptoms. Catastrophizing (i.e., helplessness) about pain and depression were significant univariate predictors of SI, but only depression predicted SI in multivariable analyses.

CONCLUSIONS

Limitations of this study include its cross-sectional design and primarily correlation-based statistics. The present study is the first to implicate multiple psychosocial risk factors over and above IC/BPS-specific symptoms and patient pain experience in SI in women with IC/BPS. Depression in particular is uniquely important in predicting suicidality. These results support a multidisciplinary, proactive approach to IC/BPS involving not only treatment of disease symptoms, but also early detection/treatment of associated psychosocial problems.